title: Pelvic organ prolapse surgery with and without tension-free vaginal tape in women with occult or asymptomatic urodynamic stress incontinence: a randomised controlled trial.
abstract: BACKGROUND
  We set out to determine if insertion of a retropubic tension-free vaginal tape (TVT) sling at the time of pelvic organ prolapse surgery improves continence outcomes in women with pre-operative occult stress incontinence (OSI) or asymptomatic urodynamic stress incontinence (USI).
  
  
  METHODS
  We conducted a randomised controlled study of prolapse surgery with or without a TVT midurethral sling. The pre- and post-operative assessment at 6 months included history, physical examination and urodynamic testing. Quality of life (QOL) and treatment success was assessed with the UDI-6 SF, IIQ-7 SF and a numerical success score. The primary outcome was symptomatic stress urinary incontinence (SUI) requiring continence surgery (TVT) at 6 months. Long-term follow-up continued to a minimum of 24 months. Secondary outcomes were quality of life parameters.
  
  
  RESULTS
  Eighty women received prolapse surgery alone (n = 43) or prolapse surgery with concurrent TVT (n = 37). Six months following prolapse surgery 3 out of 43 (7 %) patients in the no TVT group requested sling surgery compared with 0 out of 37 (0 %) in the TVT group (ARR 7 % [95 %CI: 3 to 19 %], p = 0.11). After 24 months there was one further participant in the no TVT group who received a TVT for treatment of SUI compared with none in the TVT group (4 out of 43, 9.3 % versus 0 out of 37; ARR 9.3 % [95 %CI: -1 to 22 %], p = 0.06). Both groups showed improvement in QOL difference scores for within-group analysis, without difference between groups.
  
  
  CONCLUSIONS
  These results support a policy that routine insertion of a sling in women with OSI at the time of prolapse repair is questionable and should be subject to shared decision-making between clinician and patient.
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, 163 Studley Road, Heidelberg, 3084, Victoria, Australia, lsc54031@bigpond.net.au.
authors.forename: Lore
authors.initials: L
authors.lastname: Schierlitz
authors.forename: Peter L
authors.initials: PL
authors.lastname: Dwyer
authors.forename: Anna
authors.initials: A
authors.lastname: Rosamilia
authors.forename: Alison
authors.initials: A
authors.lastname: De Souza
authors.forename: Christine
authors.initials: C
authors.lastname: Murray
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Thomas
authors.forename: Richard
authors.initials: R
authors.lastname: Hiscock
authors.forename: Chahin
authors.initials: C
authors.lastname: Achtari
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation*; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D053825:Suburethral Slings; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014563:Urodynamics